Clin Endosc.  2021 Mar;54(2):261-268. 10.5946/ce.2020.101.

Endoscopic Ultrasound-Guided Fine Needle Biopsy Needles Provide Higher Diagnostic Yield Compared to Endoscopic Ultrasound-Guided Fine Needle Aspiration Needles When Sampling Solid Pancreatic Lesions: A Meta-Analysis

• Renelus BD
• Jamorabo DS
• Boston I
• Briggs WM
• Poneros JM

• KMID: 2514182
• DOI: http://doi.org/10.5946/ce.2020.101

Abstract

Background/Aims
Studies comparing the utility of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and endoscopic ultrasound-guided fine needle biopsy (EUS-FNB) for solid pancreatic lesions have been inconclusive with no clear superiority. The aim of this meta-analysis was to compare the diagnostic accuracy and safety between the two sampling techniques.
Methods
We performed a systematic search of randomized controlled trials published between 2012 and 2019. The primary outcome was overall diagnostic accuracy. Secondary outcomes included adverse event rates, cytopathologic and histopathologic accuracy, and the mean number of passes required to obtain adequate tissue between FNA and FNB needles. Fixed and random effect models with pooled estimates of target outcomes were developed.
Results
Eleven studies involving 1,365 participants were included for analysis. When compared to FNB, FNA had a significant reduction in diagnostic accuracy (81% and 87%, p=0.005). In addition, FNA provided reduced cytopathologic accuracy (82% and 89%, p=0.04) and an increased number of mean passes required compared to FNB (2.3 and 1.6, respectively, p<0.0001). There was no difference in adverse event rate between FNA and FNB needles (1.8% and 2.3% respectively, p=0.64).
Conclusions
FNB provides superior diagnostic accuracy without compromising safety when compared to FNA. FNB should be readily considered by endosonographers when evaluating solid pancreatic masses.

Keyword

Fine needle aspiration; Fine needle biopsy; Solid pancreatic lesions

Figure

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  Fig. 1. Study selection flow diagram.

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  Fig. 2. Diagnostic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

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  Fig. 3. Cytopathologic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

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  Fig. 4. Histopathologic accuracy. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

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  Fig. 5. Technical success. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

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  Fig. 6. Mean number of passes. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk; SD, standard deviation.

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  Fig. 7. Adverse event rate. CI, confidence interval; FNA, fine needle aspiration; FNB, fine needle biopsy; RR, relative risk.

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  Fig. 8. Cochrane risk of bias.

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